Infrapopliteal stents: overview and unresolved issues.

Minimally invasive infrapopliteal angioplasty procedures are becoming the gold standard for treatment of below-the-knee arterial disease. To date, sirolimus-eluting stents have shown significant promise in inhibiting restenosis of the infrapopliteal arteries and thereby reducing recurrent leg ischemia and repeat revascularization procedures. Longer self-expanding bare stents are available to better suit the diffuse nature of atherosclerosis usually associated with critical limb ischemia. Bioabsorbable stents for transient vessel scaffolding are an elegant endovascular concept, but positive data below the knee are still lacking. It remains to be answered whether bare or drug-eluting, balloon-expandable or self-expanding, or metal versus bioabsorbable stents will have a positive impact on limb salvage to support their primary use in below-the-knee endovascular treatment.